Summary
Neurosurgeon Dr. Sanjeev Lakhia from Carolina Neurosurgery and Spine Associates provides a thorough clinical review of inversion therapy for back pain. He walks through a 2012 UK pilot randomized trial from the journal Disability and Rehabilitation, where 26 patients with lumbar disc disease were split into physiotherapy-plus-inversion and physiotherapy-only groups. The key finding was that 10 of 13 patients in the inversion group avoided surgery, compared to only 2 of 11 in the control group, though functional and pain measures were mixed. Dr. Lakhia discusses proper traction dosing (at least 60% body weight), contraindications including high blood pressure and visual disturbances, and real-world adverse events he has witnessed. The episode also covers aquatic exercise as an alternative gravity-assisted intervention for back pain.
Key Points
- A pilot RCT found inversion plus physiotherapy helped 10 of 13 patients avoid surgery vs 2 of 11 with physiotherapy alone
- Functional and pain measures (Oswestry, Roland Morris, SF-36) showed mixed results between groups
- MRI scans showed no significant structural changes from inversion, contradicting the idea it can retract herniated discs
- Traction load must be at least 60% of body weight to theoretically reduce intradiscal pressure
- Inversion tables cost $200-$300 and are widely available at retailers like Costco
- Contraindications include high blood pressure, stroke history, visual disturbances, vertigo, and head injuries
- Dr. Lakhia personally witnessed a retinal detachment case in an elderly patient using inversion
- Aquatic exercise showed strong results as an alternative gravity-assisted back pain intervention
Key Moments
How inversion tables work and what they cost
Dr. Lakhia explains that inversion tables cost $200-$300 and work by strapping you in and tilting you to varying degrees, using gravity and body weight to stretch the spine and decompress muscles, ligaments, nerves, and discs.
"Lay in it, get strapped in, and then it'll tilt you basically upside down or any varying degree of that, any angle that you decide. And what we're utilizing there is a concept of gravity and body weight. And the combination of the two theoretically can basically stretch out your spine and decompress tight muscles, ligaments, nerves, and discs."
Pilot RCT shows inversion group avoided surgery at much higher rates
Dr. Lakhia reviews a 2012 UK pilot randomized trial where 13 patients received physiotherapy plus inversion and 11 received physiotherapy alone. Ten of 13 in the inversion group avoided surgery compared to only 2 of 11 in the control group, though functional and pain measures were mixed.
"And in the group that only received physiotherapy, two avoided surgery. So that's compelling. Even if the functional measures, the pain measures, the MRI changes were equivocal or not really significant, it appears that"
Herniated discs cannot be sucked back in with traction
Dr. Lakhia addresses the common belief that traction can retract a herniated disc, comparing disc material to toothpaste out of a tube. MRI studies pre and post treatment showed no significant structural changes.
"If the disc material comes out, it's kind of like toothpaste out of the tube. You really can't put it back in. And this study kind of supports that. The MRIs pre and post treatment really didn't show any significant change."
Traction dosing and safety contraindications
Dr. Lakhia explains that effective traction requires at least 60% body weight force and warns of serious contraindications. He shares a case where an elderly patient suffered a retinal detachment from inversion, and advises against it for those with high blood pressure, stroke history, or visual disturbances.
"When I was practicing in Ohio, I did have a patient who was trying inversion. Now, she was in her 70s, and unfortunately, due to the inversion, suffered a retinal detachment."
